The Brachio-Brachial Arteriovenous Fistula

The autogenous arteriovenous fistula (AVF) is the preferred access for chronic hemodialysis in patients with end-stage kidney disease. Careful examination of the upper extremity is essential for the creation of a successful fistula. The quality of the arterial and venous circulation should be well established prior to surgery. However, there are cases when the superficial venous system of the upper extremity is unsuitable for the creation of an autogenous AVF. This problem has two solutions: the use of a prosthetic graft or the creation of a brachio-brachial AVF. Prosthetic grafts have a 1-year patency rate of 6575%(Haimov, 1978), mostly due to the frequent and varying complications that they may sustain, especially ischemia, thrombosis, infection, and aneurysms. The brachio-brachial AVF, a relatively new type of angioaccess, is shown to have similar patency rates to the prosthetic grafts, but without their number of complications and is a very good alternative for patients with an unsatisfactory superficial venous system (Dorobanţu et al., 2006, 2010).